The best helmet to prevent football concussions is….

Marshall wrote in: “My son has just had his 6th concussion this season in football. What’s the best helmet to use? I want to keep him safe.”

Marshall, football helmets are there to protect the scalp and the cranium—the bones outside of the brain. They prevent scalp lacerations (cuts), and probably prevent skull fractures. But helmets do not protect the actual brain. There is no helmet, and has never been a helmet, and never will be a helmet, that actually prevents brain injury from concussions.

Concussions aren’t caused by the head hitting another head, or a head hitting a wall. They occur inside the skull, when the brain slams into the inside of the cranium during a rapid deceleration. The brain is a soft, squishy, and very important organ suspended in essentially a bowl of water. If you drop that bowl off of your roof, say, the bowl might shatter on the ground (like a skull fracturing). But even if the bowl doesn’t break, the brain suspended in the water will suddenly go from moving very fast to not moving at all as it slams against the side of the bowl. That causes brain damage, and that’s what a concussion is. It’s not a broken bowl. It is a broken brain.

We diagnose a concussion if there’s been a blow to the head immediately followed by a period of altered brain functioning—dizziness, headache, foggy thinking or disrupted memory, or sometimes a loss in consciousness. Most concussion do not knock the athlete out—the immediate symptoms are more subtle. Even without unconsciousness, any concussion means that there has been brain damage. The damage is on the cellular level—you can’t see it on a CT scan or MRI, and those tests are not helpful and not needed after an ordinary concussion unless there’s a suspicion of a skull fracture or other problems.

The brain damage from a concussion will often heal, with appropriate rest and rehab; but repeated concussions or concussions with little time for recovery will lead to permanent brain damage. With more concussions Marshall’s son will develop lifelong problems with depression, fuzzy or easily-distracted thinking, movement disorders, and a genuine, marked drop in IQ. Good sleep and normal mood regulation can become impossible. These symptoms are, by and large, untreatable.

Marshall, your son will probably need his brain to work well as he grows older. If you’re serious about protecting his brain and mental abilities, he doesn’t need a new helmet. He needs to quit football.